“伞状三针”克氏针髓内固定治疗儿童新鲜BadoⅢ型孟氏骨折  

Intramedullary fixation of"umbrella-shaped triple-needle"for fresh BadoⅢMonteggia fracture in children

作　　者：姜远坤 刘勇 孙锋 JIANG Yuankun;LIU Yong;SUN Feng(Department of Orthopedic Surgery,Affiliated Changde Hospital of Hunan University of Traditional Chinese Medicine,Changde 415099,Hunan,China)

机构地区：[1]湖南中医药大学附属常德医院骨三科,湖南常德415099

出　　处：《中国现代手术学杂志》2024年第2期111-114,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨“伞状三针”克氏针髓内固定治疗儿童新鲜BadoⅢ型孟氏骨折的临床效果。方法回顾性分析2018年1月至2022年5月收治的18例新鲜BadoⅢ型孟氏骨折患儿的临床资料,均行闭合复位、经皮克氏针“伞状三针”髓内固定。术后随访肘关节活动度、前臂旋转活动度,复查X线评估肱桡关节对位、尺骨力线、骨痂X线评分及骨折愈合情况。末次随访采用Mayo肘关节功能评分评价临床效果。结果所有患儿手术顺利,手术时间平均(40.50±5.54)min,术中复位1~2次,术中透视7~12次。术后平均(22.00±1.79)d拆除石膏外固定,(46.94±7.06)d拔除克氏针。随访6~12个月,无针道感染、针尾激惹、缺血性肌挛缩、骨骺损伤、骨化性肌炎、骨折不愈合、延迟愈合等并发症。与拆除石膏后首次随访时相比,末次随访肘关节活动度、前臂旋转活动度及骨痂X线评分均明显改善(P<0.001)。末次随访所有患者均达到正常肱桡对合,尺骨力线恢复,骨折均愈合,按Mayo评分标准评价肘关节功能:优17例,良1例,优良率100%。结论“伞状三针”髓内固定治疗儿童新鲜BadoⅢ型孟氏骨折操作简单、疗效可靠、微创,可有效增强骨折复位后的稳定性,促进患儿肘关节及前臂功能恢复。Objective To evaluate the clinical effect of"umbrella-shaped triple-needle"intramedullary fixation with Kirschner wires in the treatment of fresh BadoⅢMonteggia fracture in children.Methods The clinical data of 18 cases with fresh BadoⅢMonteggia fracture admitted from January 2018 to May 2022 was analyzed retrospectively.Closed reduction and intramedullary fixation of"umbrella shaped triple-needle"with percutaneous Kirschner wires were performed.The activity of elbow joint,forearm rotation,brachioradial joint alignment,ulnar force line,callus of X-ray score and fracture healing were followed up after operation.The elbow joint function was assessed by Mayo elbow performance score(MEPS)at the last follow-up.Results The operation was successful in all cases.The average operation time was(40.50±5.54)min,the intraoperative reduction was 1 to 2 times,the intraoperative fluoroscopy was 7 to 12 times.Plaster fixation was removed(22.00±1.79)d after operation,and Kirschner wires were removed(46.94±7.06)d after operation.During 6 to 12 months of follow-up,there was no complications such as pin site infection,needle tail irritation,ischemic muscle contracture,epiphyseal injury,myositis ossificans,fracture nonunion and delayed union.Compared with the first follow-up after the removal of plaster,the elbow joint motion,forearm rotation motion and callus score of X-ray were significantly improved at the last follow-up(P<0.001).All fractures achieved imaging healing with normal brachioradial joint alignment and ulnar force line recovery.According to MEPS,the elbow function showed that excellence was in 17 children,good in 1 child,and the fineness rate was 100%.Conclusion The intramedullary fixation of"umbrella-shaped triple-needle"is a simple,reliable and minimally invasive method for fresh BadoⅢMonteggia fracture in children,which can enhance the stability of fracture reduction and promote the function recovery of elbow joint and forearm.

关 键 词：MONTEGGIA骨折 尺骨骨折 骨折脱位 骨折固定术 髓内 儿童 

分 类 号：R726.8[医药卫生—儿科]